405. Community Health Worker Perspectives on Barriers to HIV+ Patients’ Initiation of and Retention in Antiretroviral Therapy in Rural South Africa
Session: Poster Abstract Session: HIV Engagement in Care and the Care Cascade
Thursday, October 8, 2015
Room: Poster Hall
  • IDWeek 2015 Final Poster_405_IDWPoster.pdf (3.8 MB)
  • Background: Despite South Africa having the largest HIV/AIDS epidemic worldwide, only 42% of people living with HIV in South Africa were taking antiretroviral therapy (ART) as of 2013. Multiple barriers along the HIV continuum of care prevent patients from initiating and adhering to ART. As community members and sometimes HIV patients themselves, community health workers (CHWs) possess a unique perspective on the barriers to ART that patients face. By bridging the healthcare system and community, CHWs could function as a valuable resource in enhancing ART success.  

    Methods: We used qualitative methods to explore reasons for poor rates of both ART initiation and ART adherence among HIV patients in rural KwaZulu-Natal, South Africa. We conducted focus groups with 21 CHWs during May-August 2014. Interviews were audio-recorded, transcribed, and translated from Zulu into English. Using Atlas.ti, hybrid deductive and inductive analytical methods borrowed from grounded theory were applied to identify emergent themes.

    Results: We found that a core combination of psychosocial, socioeconomic, and socio-medical barriers— some previously unidentified in rural South Africa— act at the level of the individual, relationship/community, and healthcare environment to hinder both linkage to and retention in ART. Key themes included insufficient patient education/counseling and social support, patient dissatisfaction with healthcare services, socioeconomic factors, and tension between ART providers and alternative medicine healers. Fear of taking lifelong therapy was a barrier exclusive to non-initiation whereas substance abuse primarily contributed to default. 

    Conclusion: Successful management of HIV/AIDS requires education, counseling, and support extending beyond the initial diagnosis phase. Changing focus from HIV/AIDS as an acute infectious disease to a chronic disease model requiring a lifelong management plan appears to be key to improving ART initiation and long-term adherence. As CHWs likely appreciate these needs, the expansion of their roles to offer education for patients, partners, and family members, provide longitudinal support, and foster cooperation with alternative medicine providers could strengthen healthcare services in ways that successfully support ART initiation and adherence.

    Kelsey B. Loeliger, BS1,2, Linda Niccolai, PhD ScM1, Nonhle Mntungwa, MPA3, Anthony Moll, MBChB3, Gerald Friedland, MD, FIDSA2 and Sheela Shenoi, MD, MPH2, (1)Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, (2)Yale University School of Medicine, New Haven, CT, (3)Church of Scotland Hospital, Tugela Ferry, KwaZulu-Natal, South Africa


    K. B. Loeliger, None

    L. Niccolai, None

    N. Mntungwa, None

    A. Moll, None

    G. Friedland, None

    S. Shenoi, None

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